More than 50% of adult in-center hemodialysis patients experience and are treated for non-cancer chronic pain (NCCP). The treatment approach is often complex as the underlying etiology of the pain itself contributes to a combination of physical and psychological impairments. There is a paucity of research evidence specific to hemodialysis to guide the optimal approaches to pharmacotherapy or other innovative strategies to support patient-centered comprehensive pain management to reduce complications of pharmacologic therapy and morbidity overall. As a clinical center member of the Hemodialysis Opioid Prescription Effort (HOPE) Consortium, the overall objective of this proposal is to collaborate with diverse stakeholders to design and conduct a multi-site trial evaluating innovative strategies to reduce opioid dosing, improve quality of life and experience with care specific to pain management among adults receiving in-center hemodialysis. We propose specifically to perform a pragmatic parallel arm trial to test the impact of adding a 12-week interactive video cognitive behavioral therapy (IV-CBT) intervention program, compared to CDC guideline concordant shared decision-making (SDM) for NCCP pharmacotherapy management. The specific aims are: Aim 1 Conduct a multi-site randomized trial to receive IV-CBT and SDM versus SDM alone over 15 months; patients will be assessed at baseline, 12 weeks, 9 months and 15 months; Aim 2 Investigate and describe barriers and facilitators of the implementation of IV-CBT and also SDM among patients, clinicians and dialysis staff; Aim 3 Create a collaborative network of investigators and dialysis facilities for efficient and swift subject recruitment and for dissemination of successful strategies to optimize pain care in dialysis. In Aim 2, applicants will investigate factors related to the interventions applying the Consolidated Framework for Implementation Research (CFIR), and develop recommendations for an implementation toolkit to guide future dissemination of each of the strategies. The research is innovative because: i) it seeks to shift current clinical practice where SDM is consistently integrated into pain management clinical practice; ii) telemedicine is leveraged to support psychological and emotional support strategies to foster motivation and maintenance of multimodal strategies for chronic pain care; and iii) a trial in real-world settings of patients with multi-morbidity, who are regularly excluded from trials, is novel and has greater external validity. The results are expected to have a major positive impact as they will increase clinical understanding and underscore the importance of multidisciplinary chronic pain management strategies in tackling on the significant challenge of improving patient morbidity and quality of life in a highly prevalent and complex area of care.